Death certificate data and causes of death in patients with parkinsonism
Introduction
Despite its' significant relevance, data regarding cause of death and the relationship between neurodegenerative disorders and the possible terminal event have been overlooked over the years. In the case of Parkinson's disease (PD) and other parkinsonian disorders, gathering reliable sources of information is complex as mortality data of larger cohorts rely partially on conclusions derived from death certificate (DC) registries and other formal databanks [1]. One major limitation and source of bias in this context is the omission of the parkinsonian diagnosis on the DC. As death is the ultimate consequence of a mosaic of multiple sequential and often interrelated clinical events, picturing it objectively, necessary in these documents, is problematic [2]. Discrepancies may eventually lead to failure to recognize the potential downstream impact of comorbidities, their prognosis, and actions for supportive care and general health interventions.
The objectives of this study were firstly to evaluate records of deceased parkinsonian patients, assessing how the underlying degenerative disorder was documented on the DC. Secondly, to analyze the causes of death as described on the DCs, their potential correlation with the parkinsonian disorder, other demographic data, clinical features and comorbidities.
Section snippets
Methods
Data from deceased parkinsonian patients previously followed at a large tertiary movement disorders clinic were collected between January 2009 and January 2015. The local ethics committee approved the study protocol. All patients were regularly outpatients of the clinic prior to death, seen every three months according to a standard protocol. Clinical diagnosis was determined during their lifetime by the first or senior authors, both movement disorders specialists. To make the data analysis
Results
During the six years of the study period, the cumulative number of patients with parkinsonism followed regularly at the clinic was 1028. The cumulative number of deaths reported to the institution reached 207 (20.1%) during this time. Mean follow-up time was 35.3 ± 27.9 (range 7–117, median 29) months. Complete data was obtained from 138 cases. Eighty-four (60.9%) were male; mean age was 77.9 ± 7.9 years (44–95), mean age of onset of parkinsonism was 66.7 ± 9.8 years (35–92), and mean disease
Discussion
Our data shows that PD is under-recorded on DCs, consistent with previous studies [1], [2], [11], [12], [13]. PD was mentioned in 36.2% DCs, more commonly as an “other cause of death”. Death in chronic disorders portray the net effect of a number of concurrent conditions [14], therefore, the multiple items of a document such as the DC may include a seemingly open and incohesive list of diseases, events and co-morbidities. In any event, the chronic degenerative underlying disorder should ideally
Authors' contributions
M Moscovich: conceptualized study, analyzed data in study, drafted manuscript, revised manuscript G Boscheti: drafted manuscript, revised manuscript A Hassan: revised manuscript H A Teive: revised manuscript A Moro: revised manuscript R P Munhoz: conceptualized study, performed statistical analysis, drafted manuscript, revised manuscript.
Disclosures
All authors report no disclosure.
References (29)
- et al.
Consensus statement on the diagnosis of multiple system atrophy
J. Neurol. Sci.
(1999) - et al.
Prognostic factors for early mortality in Parkinson's disease
Park. Relat. Disord.
(2015) - et al.
Survival in Parkinson's disease. Relation with motor and non-motor features
Park. Relat. Disord.
(2014) - et al.
Mortality in Parkinson's disease is not associated with the severity of early dopaminergic defect
Park. Relat. Disord.
(2014) - et al.
Incidence and mortality trends of aspiration pneumonia in Parkinson's disease in the United States, 1979-2010
Park. Relat. Disord.
(2015) - et al.
Heart failure in Parkinson's disease: analysis of the United States medicare current beneficiary survey
Park. Relat. Disord.
(2004) - et al.
Is Parkinson's disease-related mortality declining?
Eur. J. Neurol.
(2009) - et al.
Co-morbidities of persons dying of Parkinson's disease
Prog. Palliat. Care
(2013) - et al.
Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases
J. Neurol. Neurosurg. Psychiatry
(1992)
Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop
Neurology
Consortium on DLB. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium
Neurology
Parkinsonism: onset, progression and mortality
Neurology
Clinical diagnostic criteria for dementia associated with Parkinson's disease
Mov. Disord.
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